MEDICARE: MANFRED WILLIAM NEUMANN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019022262	IL
2	1223G0001X	General Practice Dentistry	019022262	IL

General Provider Information

NPI Number	:	1568612810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANFRED WILLIAM NEUMANN DDS

Provider Business Mailing Address
First Line	:	8265 ARCHER AVE
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1586
Country	:	US
Telephone Number	:	708-467-1000
Fax Number	:	708-467-0180

Provider Business Practice Location Address
First Line	:	8265 ARCHER AVE
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1586
Country	:	US
Telephone Number	:	708-467-1000
Fax Number	:	708-467-0180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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